Diagnostic Efficacy of the Alvarado Score according to Age in Acute Appendicitis

Oh, Bo Young; Kim, Kwang Ho; Lee, Ryung Ah; Chung, Soon Sup

Abstract

PURPOSE
This study aims to assess the diagnostic efficacy of the Alvarado score and to determine cut-off values of Alvarado score according to age for deciding on the options for patients with suspected appendicitis.
METHODS
From October 2008 to January 2009, we prospectively reviewed 152 patients with suspected appendicitis. The patients were classified into adults and children groups. We then determined cut-off values of the Alvarado score by analyzing each score's sensitivity and specificity.
RESULTS
Of the 147 patients, 96 patients were adults and 51 were children. The mean Alvarado score for adults and children were 6.08+/-1.85, and 6.69+/-1.43 in appendicitis and 4.32+/-2.02, and 4.60+/-1.81 in non-appendicitis, respectively. In adults, the sensitivity of the Alvarado scores 7 or higher for appendicitis was 66.2%, and the specificity was 67.7%. And the sensitivity of the Alvarado scores 4 or lower for non-appendicitis was 58.1%, and the specificity was 81.5%. In children, the sensitivity of the Alvarado scores 7 or higher for appendicitis was 80.8%, and the specificity was 68.0%. And the sensitivity of the Alvarado scores 4 or lower for non-appendicitis was 52.0%, and the specificity was 92.3%.
CONCLUSION
The cut-off values for Alvarado score were not different according to age of the patient. If the Alvarado score is 7 or higher, surgical management is recommended, and if the Alvarado score is 4 or lower, observation without CT or US is recommended. In equivocal appendicitis as defined by the Alvarado scores 5 to 6, adjunctive CT or US are recommended to confirm appendicitis.